1. What is Anaphylaxis? Onset generally acute
A LIFE THREATENING allergic reaction that occurs
when a person is exposed to an allergen
The immune system launches
an attack by releasing powerful
chemicals into the blood stream.
This triggers symptoms of an
allergic-reaction called ANAPHYLAXIS.
Onset generally acute
Manifestations vary from mild to fatal
Anaphylaxis is a severe systemic allergic reaction: it is a response to an allergen that generally affects the body as a whole. While some anaphylactic reactions involve one organ system, such as the respiratory tract, other reactions may affect multiple systems simultaneously (including the cardiovascular and gastrointestinal systems).
An anaphylactic event is generally acute in onset, but depends upon individual patient sensitivity, the dose, and the route of administration of the allergen. Most reactions begin within an hour of exposure to the allergen. Some individuals experience symptoms within seconds, while others demonstrate symptoms hours after exposure. In general, it is believed that more severe reactions are more rapid in onset.
The manifestations of anaphylaxis can range from relatively mild symptoms, involving only the skin, to life-threatening reactions, involving the respiratory and cardiovascular systems.
Dey, L.P. Fact file on anaphylaxis: acute allergic reactions to food, medication, insect stings, latex. Napa, Calif: Dey, L.P.; 2000.
Wood RA. Identifying patients at risk for serious allergic reactions: an introduction to anaphylaxis. Abstract presented at: Anaphylaxis: Safely Managing Your Patients at Risk for Severe Allergic Reactions. Postgraduate Institute for Medicine; October 8, 1999; Washington, DC.

3. Common Symptoms Mouth itches Swelling lips & tongue Throat tightens
Mouth & Throat
Gastro-
intestinal
Respiratory
Skin
Cardio-
vascular
Mouth itches
Swelling lips
& tongue
Throat
tightens
Crampy
abdominal
pain
Nausea &
vomiting
Diarrhea
Shortness
of breath
Harsh
breathing
Cough
Wheezing
Itching
& hives
Swelling
Loss of consciousness
Sense of impending doom
Fainting, paleness & blueness
With each episode the symptoms can become more severe!

5. Treatment Immediate injection of Epinephrine is imperative
There are no contraindications
Failure or delay can bring death
The Epi-Pen must be available at all times
Benadryl used if authorized in the care plan
Call 911 & the student’s parents
Be prepared to administer CPR
Treatment must begin immediately following the onset of symptoms, as it is well known that the reaction can rapidly progress within minutes to a life-threatening event.
Epinephrine is the pharmacologic treatment of choice for an acute anaphylactic reaction. While there is reluctance by some to administer epinephrine, there are no contraindications to its use for a life-threatening allergic event. In fact, there is clear evidence that failing to use epinephrine, or delaying its use, may contribute to fatal outcomes associated with this serious disorder. Standard references recommend that epinephrine be administered by either the subcutaneous or intramuscular routes. A recent prospective randomized study has demonstrated, however, that peak drug concentrations may be higher and attained more rapidly by the intramuscular route.
An antihistamine, usually diphenhydramine, also should be administered immediately. Although antihistamines do not have any life-saving effects and should not be considered a substitute for epinephrine, they can help reduce symptoms more quickly and potentially shorten the course of the reaction. When given orally, it is best if they are given as a liquid or chewable (or rapidly dissolving) tablet for quicker absorption.
Following administration of epinephrine, a patient should be instructed to call 911 and proceed to an emergency room for follow-up medical care. Medical personnel should be told that a dose of epinephrine has been given.
Bochner BS, et al. Anaphylaxis. N Engl J Med 1991;324:1785–1790.
Yunginger JW, et al. Fatal food-induced anaphylaxis. JAMA 1988;260:1450–1452.
Simons FER, et al. Epinephrine absorption in children with a history of anaphylaxis.
J Allergy Clin Immunol 1998;101:33–37.

6. Swing out and jab the outer thigh firmly Make sure the needle goes in
Remove the cap.
Swing out and jab the outer
thigh firmly
Make sure the needle goes in
at 90 degrees
Hold in place for 10 seconds
A spring activated
mechanism releases dose
INJECT IN THIGH HOLD FOR TEN SECONDS TO RELEASE MEDICATION
With a quick motion, swing out and jab firmly into the outer thigh, so that the injector is at a 90 degree angle to the thigh. Hold firmly in the thigh for several seconds. During this time, a spring-activated mechanism is released, and a dose of epinephrine is administered. When practicing with the trainer, a “click” indicates that the device worked properly. Remove the unit and massage the injection site for an additional few seconds.
Once administration is complete, the patient should check the black tip of the auto-injector. If the needle is exposed, a dose of epinephrine was injected. If not, the above steps should be repeated. Inform the patient that most of the liquid (90%) stays in the auto-injector after the dose is administered and cannot be reused.
To avoid an accidental needle stick, the needle of the fired unit should be bent back against a hard surface. Carefully return the auto-injector to its carrying tube (NEEDLE FIRST) without replacing the gray safety cap. Recap the carrying tube and bring it to the emergency care facility for proper disposal.
Patients should be instructed to go immediately to the nearest Emergency Room for further medical attention. Medical personnel should be told that a dose of epinephrine has been given and should dispose of the auto-injector properly.
Patients should be reminded to store their EpiPen/EpiPen Jr in a dark place at room temperature; prolonged temperature extremes (refrigeration or car glove box, trunk) should be avoided for optimal functioning of the auto-injector. Patients should check the EpiPen/EpiPen Jr monthly for expiration date and discoloration. If the unit has expired or the drug solution appears brown, the unit should be discarded and replaced immediately.
EpiPen/EpiPen Jr package instructions. Napa, Calif: Dey, L.P., December 2000.